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Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.)

Chapter 17: AIDS (Acquired Immune Deficiency Syndrome)

(introduction...)

What Are HIV and AIDS?

(introduction...)

How HIV/AIDS is spread and is not spread

Why HIV and AIDS Are Different for Women

Preventing HIV/AIDS

The HIV Test

Living Positively with HIV and AIDS

Pregnancy, Childbirth, and Breastfeeding

Care for Persons with AIDS

(introduction...)

Preventing HIV infection at home

Staying Healthy for as Long as Possible

Common Medical Problems

(introduction...)

Fever

Diarrhea

Skin rashes and itching

Nausea and vomiting

Cough

Problems with the mouth and throat

Wounds and sores

Mental confusion (Dementia)

Pain

Caring for Someone Who Is Near Death

Working for Change

(introduction...)

How you can help prevent AIDS

Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.)

Chapter 17: AIDS (Acquired Immune Deficiency Syndrome)

Figure

¨ AIDS is everyones
problem.

You must have heard about AIDS by now - on the radio, in the
market, from your neighbors, or at the health center. You may think AIDS is not
your problem. Yet millions of people are infected with the AIDS virus.
More and more of them are women.

We can only protect ourselves from AIDS if we understand what
AIDS is, and if we talk about AIDS with our families and friends.

AIDS is a disease that shines in hush and thrives on
secrecy. It was prospering because people were choosing not to talk about it...
I wanted to talk about AIDS so that at least my children, and yours, would be
spared. They would know and have the information about AIDS before they became
sexually active, and be able to talk about it.

- Noerine Kaleeba, Uganda, whose husband died of
AIDS

WHY SO MANY WOMEN GET HIV/AIDS

AIDS is spreading fastest in parts of the world where people are
poor and do not have education. If there is famine (not enough food), war, or
not enough work, people are often forced to move to cities, away from their
families. Traditions often break down and sex with new partners is common.

These conditions are especially hard for women. Poor women have
even less power to control their lives. Often laws and tradition keep women from
getting an education, skills to support themselves, or information about their
bodies.

¨ Lack of power and
information make women more vulnerable to
AIDS.

What Are HIV and AIDS?

HIV (Human Immunodeficiency Virus) is a
very small germ, called a virus, that you cannot see. AIDS is a disease that
develops later, after a person has been infected with HIV, the AIDS virus.

HIV

When a person becomes infected with HIV, the virus attacks the
immune system, the part of your body that fights off infection. HIV slowly kills
the cells of the immune system until the body cannot defend itself against germs
anymore. Although a person may feel well for only a short time, many people feel
well for 5 to 10 years after getting HIV. But eventually the immune system will
no longer have enough cells to fight off germs that normally do not make you
sick. Because HIV takes many years to make someone sick, most people with HIV
feel healthy and do not know they have it.

¨ As long as you feel well
you have HIV, but you do not yet have AIDS.

IMPORTANTYou can pass HIV to others as soon as
you are infected, even though you look and feel healthy. You cannot tell from
looking at a person if he or she has HIV. The only way to know if you are
infected is to get the HIV test.

Figure

The body has millions of white blood cells that attack germs
and fight off infection.

HIV kills the white blood cells until there are not enough
cells left to attack the germs. This is when the person has AIDS.

AIDS

A person has AIDS when the immune system gets so weak that it
can no longer fight off common infections and illnesses. The signs of AIDS are
different in different people, and they can be different for women than for men.
Often the signs are lasting infection with other common illnesses.

Good nutrition and some medicines can help the
persons body fight infections caused by AIDS and allow her or him to live
longer. But there is no cure for AIDS itself. So after a while, a person
infected with HIV will get more and more illnesses until the body is too weak to
survive.

How HIV/AIDS is spread and is not spread

HOW HIV/AIDS IS SPREAD

HIV lives in body fluids - such as blood, semen, and the fluids
in the vagina - of people infected with HIV. The virus is spread when
these fluids get into the body of another person. This means that HIV/AIDS
can be spread by:

unsafe sex with someone who
has the virus.

unclean needles or syringes,
or any tool that pierces or cuts the skin.

blood transfusions, if the
blood has not been tested to be sure it is free from HIV

an infected mother to her baby
through pregnancy, birth or breastfeeding.

infected blood that gets into
cuts or an open wound of another person.

HOW HIV/AIDS IS NOT SPREAD

HIV does not live outside the human body for more than a few
minutes. It cannot live on its own in the air or in water. This means you
cannot give or get HIV in these ways:

Why HIV and AIDS Are Different for Women

HIV and AIDS are different for women because:

· women get infected
with HIV more easily than men do. A man puts his semen in the womans
vagina, where it stays for a long time. If there is HIV in semen it can pass
easily into a womans body through her vagina or cervix, especially if
there are any cuts or sores.

· women are often infected at a
younger age than men. This is often because young women and girls are less able
to refuse unwanted or unsafe sex.

· women get more blood
transfusions than men because of problems during childbirth.

· women become sick with AIDS
more quickly after becoming infected with HIV than men do. Poor nutrition and
childbearing may make women less able to fight disease.

· women are blamed unfairly for
the spread of AIDS. But men are just as responsible as women (if not more). For
example, they are the ones who buy sex, which is a common way that AIDS spreads.

· a pregnant woman infected with
HIV can pass it to her baby.

· women are usually the
caretakers for family members who are sick with AIDS, even if they are sick
themselves.

Preventing HIV/AIDS

You can prevent AIDS in these ways:

· If possible, have
sex with only one partner who has sex only with you.

· Practice safer sex - sex that
prevents the germs in a mans semen from getting into your vagina, anus, or
mouth.

· Avoid piercing or cutting the
skin with needles or other tools that have not been disinfected between uses.

· Avoid blood transfusions
except in emergencies.

· Do not share razors or
toothbrushes.

· Do not touch someone
elses blood or wound without protection.

Figure

Women and girls should have a
right to protect their lives against AIDS. To do this we need

PREVENTING HIV/AIDS IS NOT ALWAYS EASY

Figure

Figure

Figure

The HIV Test

When HIV enters the body, the body starts to make antibodies
right away to fight the virus. These antibodies usually show in the blood 4 to 8
weeks later, but it can take as long as 6 months for the body to make enough of
them to show up in a test. This time between infection and when the antibodies
appear in the blood is called the window period.

¨ Your local Red Cross or Red
Crescent may offer testing and counseling at a low cost, Check with your
national AIDS control program to find out where you can be tested in your
country. It can take about 2 weeks to get the test results.

The HIV test looks for these antibodies in the blood. It is the
only way to know if a person has been infected with HIV. It is not a test for
AIDS.

A positive HIV test means that you are infected with the
virus and your body has made antibodies to HIV. Even if you feel completely
well, you can spread the virus to others.

A negative HIV test means I of 2 things:

· you are not
infected with HIV, or· you are infected but
have not yet made enough antibodies to HIV to test positive (the window
period).

If you have tested negative for HIV but think you might be
infected, you should take the test again in a few months. Sometimes a positive
test also needs to be repeated. A health worker can help you decide.

¨ If possible, have someone
you trust go with you to get your HIV test results.

THE WINDOW PERIOD

This is different for different people. Here is an example of
how long the window period was for one woman:

1.Hewas HIV-infected. They had unprotected
sex. She became infected too.

Figure

2. Three weeks later, she tested negative for HIV. But
she was still infected and could give the virus to others. She was in the
window period.

Figure

3. Nine weeks later she tested positive for HIV.

Figure

4. The time between her first contact with HIV, and
when antibodies appear in her blood is the window period.

Figure

Since the window period can be as long as 6 months, it is best
to wait that long after being exposed before getting the HIV test If you think
you may have come into contact with HIV again during that 6-month window period,
you will need to get another test in 6 months from the date of the new contact.

WHEN SHOULD YOU HAVE THE HIV TEST?

It is usually more important to change unsafe behavior than to
have an HIV test. But you and your partner may want to be tested if:

· you want to get
married (or start a faithful sexual relationship with one person) or have
children.

· you, your partner, or your
baby have signs of AIDS.

· you or your partner have had
unsafe sex.

¨ The HIV test should
always be done:

·
with your permission.· with
counseling before and after the test.· with privacy. No one should know the
results except you and those you want to know.

The advantages of knowing the test results

If your test is negative, you can learn how to protect
yourself so that you stay negative and never get HIV/AIDS.

If your test is positive, you can:

· prevent the spread
of HIV to your partner.· get treatment early
for health problems.· make changes in how
you live so you can stay healthy longer.·
get support from other HIV-infected people in your community.· plan for yourself and your familys
future.

The disadvantages of knowing the test results

You may have many different feelings if you find out you are
infected. It is normal at first to be shocked and deny that your test results
are positive. You may also feel anger and despair, and blame yourself or others.

AIDS is not a curse or a
punishment.

It often helps to talk with someone, such as the health worker
who gave you the test results or someone close to you. But be careful who you
tell. Your husband or partner may blame you, even if he is also infected with
HIV. Other people may act afraid and shun you, because they do not understand
HIV/AIDS or how it is spread. If possible, see a trained HIV/ AIDS counselor,
who can help you decide who to tell and how to face this change in your life.

IMPORTANTA negative test does not mean that you
will never become infected with HIV. If you practice unsafe sex, you can still
get infected.

Figure

Practice safer sex.

Counseling

A counselor is someone who listens and talks with a person and
his or her family to help them to cope with their worries, concerns, and fears,
and to make their own decisions.

¨Counseling for
HIV-infected people and their families can mean the difference between hope and
despair. As an HIV-infected woman from Kenya says, When you meet a good
counselor, you feel as if you have healed.

Figure

Counseling is important throughout the life of a person with
HIV, not only when they first discover they are infected. If you are infected, a
skilled counselor may be able to help you:

· decide who to tell
about being HIV-infected.

· find the support of others who
are also HIV-infected.

· get the care you need from
health centers.

· explain to your family what it
means to be HIV-infected, and how HIV is spread. This will help them to accept
and care for you without being afraid.

· understand how to stay healthy
for as long as possible.

· plan for your future.

· learn how to be sexual in a
safe way.

If you are a health worker or a leader of a religious group,
you are in an ideal position to get training to help those suffering with the
problems of HIV. Some people who have lost family members to AIDS have learned
to counsel others about living with HIV.

Living Positively with HIV and AIDS

¨Most people with HIV
can be healthy for many years.

Modern medicine and traditional healers still do not have a cure
for AIDS. But most people with HIV can be healthy for many years. During this
time it can help to:

· make the best
of every moment of your life.· spend
time with friends and family.· try to
keep active by doing your daily work.· be sexual if you want to. Enjoying sexual touch
can help you stay healthier longer

If your partner is HIV infected

Although it is risky, if you practice safer sex carefully, you
can continue to have sex with an HIV infected partner without becoming infected
yourself. Besides using safer sex methods, watch your own health carefully.
Watch for breaks in the skin or other places where infection could occur. And
remember, there are other ways to be sexual besides having sex. It is safe to
hug, to hold someone in your arms, and to kiss them.

Figure

·Try joining or starting a
group of people with HIV and AIDS. Some people with HIV and AIDS work
together to educate the community, to provide home care to those who are sick
with AIDS, and to support the rights of people with HIV and AIDS.

Figure

Figure

· Look after your spiritual
and mental health. Your faith and traditions can bring you hope and
strength.

Figure

· Think about the future.
If you have children:

- spend time with them now, and give them care and
guidance.

- make arrangements for family members to look after them when
you are no longer able to do so.

- make a will. If you have some money, a house, or
property, try to make sure that they will go to those you want to have them.
Sometimes women who are not legally married cannot leave their possessions to
their children and other family members. So it may be helpful to get legally
married in order to leave your possessions to those you want to have
them.

¨ If you have children, make
staying healthy for them a goal.

Take care of your health

· Take care of medical
problems early. Each infection can weaken your immune system more.

· Eat nutritious food to keep
your body strong. The same foods that are good to eat when you are healthy
are good for you when you are sick. Buy nutritious food instead of spending
money on vitamin tablets or injections.

· Avoid tobacco, alcohol, and
other drugs.

· Practice safer sex for
your own health as well as your partners. Safer sex can prevent new
infections and unplanned pregnancies that could weaken the immune system even
more.

· Try to get enough rest and
exercise. This will help your body stay strong to fight infection.

· Prevent infection by
washing often.

Figure

Pregnancy, Childbirth, and Breastfeeding

Preventing pregnancy may keep you healthier and help you live
longer. If you are HIV infected and already pregnant, it is especially important
to take good care of yourself.

Figure

PREGNANCY

Pregnancy can be dangerous for a woman with HIV or AIDS. During
pregnancy and childbirth she is more likely to have some of the following
problems than a woman who does not have HIV or AIDS:

· lose the baby
during pregnancy (miscarriage)· fevers,
infections, and poor health· serious
infections after giving birth, which are hard to treat and may threaten her
life

In addition, her baby may:

· be infected with
HIV.· be born too soon, or be sickly and
die.

Some women who become infected with HIV may still want to get
pregnant Or they may have no way to prevent pregnancy.

If you want to get pregnant

If you are not sure whether you or your partner are infected
with HIV and you can get a test for HIV, both of you should wait 6 months before
having the test. While you wait, use condoms every time you have sex, and have
sex with only each other.

If you cannot get an HIV test, you can reduce your risk by
following this advice:

· Have sex with a
condom, except during your fertiletime.·When you are not fertile, practice safer
sex.· Never have sex when there are signs of
an STD.

Figure

About 1 out of 3 babies born to HIV-infected mothers becomes
infected.

This baby is HIV
positive.

These 2 babies are HIV
negative.

A baby can become infected while it is in your womb, or
during birth, or while breastfeeding. Some anti-viral drugs (like AZT) are being
tested that may reduce the risk of passing HIV to your baby. Check with a health
worker who has been trained to treat HIV/AIDS during pregnancy.

An HIV-positive mother always passes antibodies (but not always
HIV itself) to her unborn baby. This means that a new baby will always test
positive for HIV because the mothers antibodies show up in the babys
blood. But many babies later have a negative test. This means they were not
actually infected with HIV itself. It is impossible to tell from the usual HIV
test if the baby has the virus or just the antibodies until the baby is I 8
months old. At that time, the mothers antibodies will disappear from its
blood.

CHILDBIRTH

If you think your midwife or birth attendant would be
understanding, tell her that you are HIV infected so she can protect both of you
from infection.

After the birth, wash your genitals 2 times a day with mild soap
and clean water Learn the signs of infection after birth and get treated
immediately if necessary.

Figure

BREASTFEEDING

HIV infection is sometimes passed to the baby in breast milk. No
one knows yet how often this happens or why it happens to some babies and not
others. There is more HIV in the breast milk of mothers who have become infected
recently, and in those who are very sick with AIDS.

Figure

Some mothers find a friend or relative who is not HIV infected
who can breastfeed their baby for them. This can be the safest choice for your
baby. But even if you are HIV infected, it is usually better to breastfeed than
to use other milks or formula. In many communities the risk of
diarrhea and malnutrition from other milks is greater than the risk
of HIV, especially in the babys first 6 months of life.

After 6 months, when your baby is bigger and stronger, there is
less danger of diarrhea and infection. You can then switch to other milks and
feed your baby other foods. This way your baby has many of the benefits
of breastfeeding with less risk of getting HIV.

Figure

Talking with a trained health worker about breastfeeding and HIV
can help you answer some of the following difficult questions and make a
decision about whether to breastfeed your baby:

· Are you certain
you have HIV or AIDS? Perhaps you should be tested.

· Do children in your area often
get sick or die from infections, diarrhea, or poor nutrition? If the answer is
yes, then breastfeeding may be best.

· Are other clean, nutritious
milks or formula available? You will need to buy them for at least 6 months,
which is very costly. You will also need enough clean, boiled water and some
training in how to feed other milks or formula with a cup or spoon.

· Is there another woman who can
breastfeed your baby? Are you certain she is not infected with HIV?

Figure

Whatever you choose to do, do not blame yourself if your baby
becomes infected with HIV. There is no way to know for sure how to protect your
baby.

Care for Persons with AIDS

The health and medical problems of AIDS may last a long time.
These problems can take a lot of the energy and resources of the sick person and
her or his family.

If you have AIDS, you will probably need to see a health
worker or go to a clinic from time to time to have an infection treated. But you
may never need to stay in the hospital. You may be more comfortable at home,
cared for by family members in familiar surroundings.

If you have a problem that does not get better with home
treatment, try to find a health worker, clinic, or doctor you trust who is
experienced with AIDS. Then go to the same person whenever you have a problem.
Going from clinic to clinic wastes time, energy, and money.

A stay in the hospital usually costs more than the food and
medicine needed for good care at home.

Figure

Figure

¨ A good counselor is key to
helping you care for someone with AIDS at home.

Much of the work in caring for sick people at home is done by
women, who are usually the familys caregivers. If you are caring for
someone with AIDS, be sure to take care of your own needs, too. Try to get
help from other family members, friends and people in the community. Community
clubs, religious groups, youth clubs, and AIDS self-help groups may assist you.

When Rosa was in bed because of AIDS complications, her
mother kept a cheerful attitude. Every day she bathed her daughter dressed her
with nice clothes, and put a little flower next to her bed. Rosa was not hungry
but her mother arranged the food in a way that could make her want to eat. The
family would talk to Rosa about daily life, and their work and community. With
their good humor and positive comments, Rosa felt that she was not cast aside.
Even though Rosa was often tired or didnt feel well, the family arranged
for her friends to visit her in the moments she felt better. Music,
conversation, and good spirit made the house full of life. Rosa felt that she
was loved and needed, and that AIDS could not ruin her closeness and her time
with her family.

Figure

Preventing HIV infection at home

If you follow these rules, there is no risk of spreading HIV
from an infected person to others around her, or of getting HIV yourself:

· Avoid touching
body fluids, like blood, vomit, stool, and urine.

· Do not share anything that
touches blood. This includes razors, needles, any sharp instruments that cut the
skin, and toothbrushes. If you must share such things, disinfect them
before another person uses them. If you are unable to disinfect them, boil them
in water for 20 minutes.

Figure

Figure

¨ Burn or bury soiled
bandages that cannot be rewashed.

· Keep wounds
covered. Both caregivers and persons with HIV or AIDS should cover all open
wounds with a clean bandage or cloth.

· Use a piece of plastic or
paper gloves, or a big leaf to handle dirty bandages, cloths, blood, vomit, or
stool.

Figure

· Wash your hands
with soap and water after changing dirty bedding and clothes.

· Keep bedding and clothing
clean. This helps keep sick people comfortable and helps prevent skin problems.
To clean clothing or sheets stained with blood, diarrhea, or other body
fluids:

- keep them separate from other
household laundry.

- hold an unstained part and rinse off any body fluids with
water. Be especially careful if there are large amounts of blood, such as after
childbirth.

- wash the bedding and clothing in soapy water, hang to dry - if
possible in the sun - and fold or iron as usual.

You will not get HIV from
washing the clothes of an infected person if you follow the advice
above.

¨ The following things are
helpful but not necessary:

· Add bleach to
the soapy water and soak 10 minutes before washing.· Wear gloves or plastic bags on your
hands.

Figure

Staying Healthy for as Long as Possible

When a person has AIDS, the bodys immune system is no
longer able to fight off common infections and illnesses. The immune system gets
weaker with each illness, making it even less able to fight infection the next
time. This continues until the persons body is too weak to survive.

Preventing infections and illness is the best way to slow down
the weakening of the immune system. It is also important to treat any infections
to keep them from spreading or getting worse. This way a person with AIDS can
stay healthy for as long as possible.

Preventing some infections with medicines

For persons with AIDS, regular use of the antibiotic
co-trimoxazole may help prevent some kinds of pneumonia and diarrhea.
You can start taking it as soon as you begin to fall ill from serious lung
infections, diarrhea, and skin infections.

Take: co-trimoxazole 480 mg (80 mg trimethoprim and 400 mg
sulfamethoxazole), I tablet by mouth daily, or 2 tablets by mouth 2 times
a week. Drink a lot of water every day if you take co-trimoxazole.

IMPORTANTAllergic reactions to co-trimoxazole
are more common in persons with AIDS. Stop taking it if you get a new skin rash
or any other sign of drug allergy. Taking antibiotics regularly usually causes
problems with fungal infections of all kinds: in the mouth, on the skin, in the
vagina. You may be able to prevent some of these infections by eating yogurt or
sour milk products every day.

Women will usually have more problems with yeast infections
of the vagina when they take antibiotics. Eating yogurt or sour milk, or
sitting in a bowl of water with yogurt or vinegar in it can help.

MENTAL HEALTH

Figure

Good mental health is very important for staying healthy and
avoiding illness. AIDS places a heavy stress on the mind and the emotions. Often
people feel very afraid and tense (anxiety), or feel sadness or have no feelings
at all (depression). Sometimes these feelings are so strong they cause physical
signs. Anxiety and depression can also weaken the body and make a person more
likely to get sick.

It is important to try to tell the difference between signs of
illness that are caused by physical problems, and signs that are caused by
anxiety or depression. Knowing the cause of a problem may make it easier to
treat. It is also important to try and overcome these feelings so that they do
not contribute to making a person with AIDS become sicker.

Figure

Common Medical Problems

A person with AIDS can get sick very easily from many different
common medical problems. The rest of this chapter has information about the most
common of these problems and how an individual or family may care for them.

Just because someone has one of these problems does not mean
she has AIDS. This information will be helpful to anyone suffering from one
of these illnesses.

¨ For the medical problems
mentioned in this chapter, also see Where There Is No Doctor or another
general medical
book.

Fever

Fevers often come and go. It is hard to know if the fever
is from an infection that can be treated, like tuberculosis, pelvic
inflammatory disease (PID), or malaria, or if it is from HIV itself.
If the fever is caused by an infection, then make sure the infection itself is
also treated.

To check for fever, use a thermometer, or put the back of
one hand on the sick persons forehead and the other on your own. If the
sick person feels warmer, she probably has a fever.

Figure

Figure

Treatment:

· Remove extra
clothing and let fresh air into the room.

· Cool the skin by pouring water
over it, wiping the skin with wet cloths, or putting wet cloths on the chest and
forehead and fanning them.

· Give plenty of liquids even if
the person is not thirsty. With fever it is easy to become dehydrated (lose too
much water).

· Take a medicine like
paracetamol, aspirin, or ibuprofen to help reduce fever.

· Keep the skin clean and dry.
Use lotion or corn starch to help prevent sores and rashes.

Get help when:

· the temperature is
very high.

· the fever goes on for many
days.

· there is coughing, difficulty
breathing, and loss of weight.

· there is a stiff neck, severe
pain, or sudden, severe diarrhea with the fever.

· the person with the fever is
pregnant or recently had a baby, miscarriage, or abortion.

· the person is being treated
for malaria, and the fever has not gone away after the first treatment.

· there is discharge from the
vagina and pain in the belly with the fever

Figure

Figure

Diarrhea

Diarrhea is passing 3 or more loose or watery stools in a day.
Passing many normal stools is not the same as having diarrhea. Diarrhea may come
and go and can be hard to cure. The most common causes of diarrhea in persons
with AIDS are infections in the intestines from unclean food or water,
infection because of HIV, or the side effects of some medicines.

Diarrhea can cause:

·malnutrition, if the food passes through the body so quickly that the
body cannot use it. Also, people with diarrhea often do not eat because they are
not hungry.

· dehydration, if the
body loses more liquid in the stools than you take in. Dehydration happens
faster in hot climates and in people who have fever.

Signs of dehydration:

· thirst· little or no urine· dry mouth· loss
of stretchiness of the skin· feeling
dizzy when standing up

Lift the skin between two
fingers...

...if the skin fold does not
fall right back to normal, the person is dehydrated.

IMPORTANTIf someone has these signs and is also
vomiting, she needs liquids in the vein (IV) or in the rectum. Get medical help
fast. Severe dehydration is an emergency.

Treatment:

· Prevent
dehydration by drinking more liquids than usual. Fruit juices, coconut milk,
sweetened weak tea, gruel, soup, rice water, and rehydration drink are good for
fighting dehydration. Even if the person does not feel thirsty, she should still
sip something every 5 to 10 minutes.

· Keep eating. Try to eat
small amounts of foods that are easy for the body to digest. Cook food well, and
then mash and grind it. Some good foods are cereals mixed with beans, meat, or
fish; dairy products, such as milk, cheese and yogurt; and bananas. Do not eat
uncooked vegetables, whole grains, fruit peels, hot peppers, or food or drink
with a lot of sugar. These make diarrhea worse.

Figure

Take medicine only for these kinds of diarrhea:

· Sudden, severe
diarrhea with fever (with or without blood in the stool). Take co-trimoxazole
480 mg (80 mg trimethoprim and 400 mg sulfamethoxazole), 2 tablets twice a day
for 10 days. If you are allergic to sulfa drugs, take norfloxacin instead, 400
mg, one time only. If you are no better after 2 days, see a health worker.

· Bloody diarrhea without fever,
which can be caused by amoebas (tiny animals that live in water or in the
intestines). Take metronidazole 500 mg, 3 times a day for 7 days. If you are not
better after 2 days, see a health worker.

· When someone has diarrhea
for a long time, she may get a red, sore area around the anus. It may
help to apply petroleum gel or zinc oxide cream each time after passing stool.
The person may also get piles (hemorrhoids).

¨ If you are pregnant or
breastfeeding, do not take norfloxacin. For more information about these
medicines, see the Green Pages.

Figure

Get help if the person:

· has the signs of
dehydration.· cannot eat or drink as
usual.· does not seem to be getting better
no matter what she does.· has a high
fever.· passes many watery stools in a
day.· passes bloody stools the do not go
away with medicine.· is also
vomiting.

Figure

Prevention:

· Drink clean
water. Purify your water before using it in food or drink.

· Eat clean, safe food.
Make sure raw foods are washed or peeled, and that meat is well cooked.
Protect food from dirt, flies, crawling insects and animals, which can give you
germs.

· Always wash your
hands:

- after using or helping someone use the
latrine or toilet.- after cleaning soiled children or sick
people.- before making food or drink.

Figure

· Protect your
communitys water source.

Figure

Skin rashes and itching

It is often difficult to know what causes skin rashes and
itching. Many skin problems can be helped by keeping the body clean. Try to wash
once a day with mild soap and clean water

If the skin becomes too dry, wash less often and do not use
soap. Try rubbing petroleum gel, glycerin, or vegetable oils into the skin after
bathing. Wear loose cotton clothing.

Figure

Allergic reactions

Allergic reactions, which often cause an itchy rash, are more
common in people with AIDS. Medicines that contain sulfa (like co-trimoxazole)
may cause especially bad reactions. If you are using these medicines and you get
an itchy rash, itchy eyes, vomiting or dizziness, stop taking them
immediately and see a health worker. She may be able to give you a non-sulfa
medicine that will work.

Fungal infections (yeast, Candida)

Fungal infections are difficult to describe because they can
look like many different things. Some fungal infections look like round, red, or
scaly patches that itch. Women with AIDS can also get frequent yeast infections
in the vagina.

You may have a fungal infection if you have a skin problem in
one of these areas:

Figure

Treatment:

· If you have red,
itchy patches, keep the area clean and dry. If possible, keep the area uncovered
and open to the air and sunlight.

· Apply nystatin cream 3 times a
day or Gentian Violet 2 times a day until the rash is completely gone.

· If you have a very bad fungal
infection, taking ketoconazole by mouth may help. Take one 200 mg tablet each
day for 10 days (but do not take this medicine if you are
pregnant).

Brown or purple patches on the mouth or skin

These patches are caused by a cancer of the blood vessels or
lymph nodes called Kaposis sarcoma. Medicines are not helpful. If
you are having problems, like difficulty eating because of patches in your
mouth, see a health worker.

Itching

Treatment without medicines:

· Cool the skin or
fan it.

· Avoid heat and hot water on
the skin.

· Avoid scratching, which causes
more itching and sometimes infection. Cut the fingernails short and keep them
clean to avoid infection.

Figure

· Use cool cloths
soaked in water from boiled and strained oatmeal, or plant medicines from local
healers.

These can also help itching:

· tincture of tea
tree from Australia

· juice from aloe vera
plants

Figure

Treatment with medicines (use any one of these):

·Apply
calamine lotion with a clean cloth as needed.

· Apply small amounts of 1%hydrocortisone cream or ointment 3 times a day.

· Take an antihistamine, such as
diphenhydramine or hydroxyzine, by mouth. Take 25 mg, 4 times a day.
Antihistamines may make you sleepy.

¨ Antihistamines should be
used with caution by women who are pregnant or breastfeeding (see the
Green Pages).

Herpes zoster (shingles)

Shingles is an infection caused by a herpes virus. It usually
begins as a painful rash with blisters, which may then break open. It is most
common on the face, back, and chest. The area may burn and be very painful. The
rash may start to heal in a few weeks, but the pain may last longer.

· To prevent infection, apply
Gentian Violet liquid. If the sores do become infected, see Wounds and
Sores.

· Pain medicine is often needed.

· The medicine acyclovir may
help.

Do not touch your eyes because shingles can damage your eyesight
and can cause
blindness.

Nausea and vomiting

Figure

If nausea and vomiting prevent a person from eating or drinking,
she can become weak, malnourished, and dehydrated. For some people, nausea or
vomiting may go on day after day. Nausea and vomiting may be caused by:

·
infections.· some medicines.· problems with the stomach and
intestines.· HIV infection
itself.

Treatment:

· Take small bites
of dry food (bread, crackers, chapati, tortilla) when you wake up in the
morning.

· Try to avoid the smell of food
as it cooks. If a food or smell seems to cause nausea, avoid that food.

· Drink small amounts of mint,
ginger, or cinnamon tea.

· Lick a lemon.

· Clean the teeth and rinse the
mouth often, to get rid of the bad taste after vomiting.

· Let fresh air into the house
or room often.

· Soak a cloth in cool water and
put it on the forehead.

· If the problem is caused by a
medicine, see if another medicine can be used instead.

Figure

If vomiting is severe:

1. Do not drink or eat for 2 hours.

2. Then, for the next 2 hours, sip 3 tablespoons of
water, rehydration drink, or other clear liquid every hour. Slowly increase the
amount of liquid to 4 to 6 tablespoonfuls every hour. If the person does not
vomit, keep increasing the amount of liquid.

4. If the person cannot stop vomiting, use promethazine
25 mg to 50 mg every 6 hours as needed.

5. As nausea gets better, start to eat small amounts of
food again. Start with plain foods such as bread, rice, cassava, or
porridge.

Figure

When to get help:

· The person cannot
keep any food or drink in her body for 24 hours.

· The person vomiting has pain
in the belly or a high fever

· The vomiting is very strong,
it is dark green or dark brown, it smells like stool, or has blood in it.

· The person has signs of
dehydration.

Cough

Coughing is the bodys way of cleaning the breathing system
and getting rid of mucus. Coughing is also a common sign of lung problems, such
as pneumonia or tuberculosis. The lungs make more mucus when they are irritated
or infected.

¨ DO NOT smote if you have a
cough.

When a cough produces mucus, do not take medicine to stop the
cough. Instead, do something to help loosen and bring up the mucus. This will
make the cough heal faster

¨ Persons with AIDS often get
pneumonia or TB. For more information, see below.

Treatment:

· Drink lots of
water. Water is better than any medicine. It loosens the mucus so you can cough
it up more easily.

· Cough several times during the
day to clear the lungs. Be sure to cover your mouth.

· Keep active by walking, or by
turning in bed and sitting up. This helps the mucus come out of the lungs.

· Soothe the throat by drinking
tea with lemon and honey, or your own herbal remedy. Cough syrups that you buy
are more expensive and no more helpful.

· If the cough is very bad and
keeps you awake at night, take codeine, 30 mg, or codeine cough
syrup.

Have someone hit you on the back of the chest (postural
drainage). This can make it easier to cough up the mucus.

Figure

IMPORTANTIf you cough up yellow, green, or
bloody mucus, the cough could be caused by pneumonia or TB, and you will need
special medicines.

TUBERCULOSIS (TB)

Tuberculosis (TB) is a serious infection caused by a germ that
usually affects the lungs. The signs of AIDS and TB are similar, but they are
different diseases. Most men, women, and children with TB do not have
AIDS.

But someone with AIDS can get TB very easily because the
persons body is too weak to fight it. In I out of every 3 people who die
from AIDS, it is TB that actually kills them.

A woman infected with HIV/AIDS is even more likely to get TB if
her body is also weak from many pregnancies, poor nutrition and weak blood
(anemia).

TB can be cured, even in persons with AIDS, so it is important
to get treatment early. Butpeople with AIDS should never take
thiacetazone for TB. For complete information, see the chapter on
Tuberculosis.

You can make this syrup for all kinds of cough, especially a
dry cough. Take 1 teaspoon every 2 or 3 hours.

Mix:

Figure

Pneumonia

Pneumonia is caused by germs that infect the small breathing
tubes deep in the lungs. Old people and very sick or weak people often get
pneumonia.

Pneumonia can be very serious for people with AIDS. It should be
treated with antibiotics right away. Sometimes pneumonia must be treated in the
hospital with medicines in the vein (IV).

Figure

Signs:

· Breaths are small
and fast (more than 30 breaths a minute in an adult). Sometimes the nostrils
open wide with each breath.

· You feel as if you cannot get
enough air

· You have a sudden, often high,
fever.

· You cough up mucus that is
green, rust-colored, or bloody.

· You feel very
ill.

Treatment:

· Take
co-trimoxazole for 10 days or more (see the Green Pages).· Drink plenty of liquids.· Try to bring the fever down.· If you are no better in 24 hours or if you are
getting worse, get medical help right
away.

Problems with the mouth and throat

Problems with the mouth, or with other parts of the body that
food passes through, can keep a person from eating normally. She may then become
weak, malnourished, and have a harder time fighting infections. She should try
to:

· eat small amounts
of food often.· add vegetable oil or
groundnut paste (peanut butter) to foods to give more energy.· avoid uncooked vegetables. They are hard for the body
to digest and may have germs.· drink a lot
of liquids and watch for dehydration.

Figure

Using a straw to drink can help with painful mouth
problems.

Soreness in the mouth and throat

Many people with AIDS have soreness in the mouth, and problems
with their teeth and gums. Try to:

Painful blisters and sores (also called cold sores or
fever blisters) on the lips can be caused by the herpes virus. A healthy
person can get these sores after a cold or fever. Someone with AIDS can get
these sores at any time. The sores may last a long time, but they usually go
away on their own. To help prevent infection, apply Gentian Violet to the sores.
A medicine called acyclovir may also help (see the Green Pages).
Wash your hands after touching the sores.

Figure

¨ Cracks and sores in the
corner of the mouth can also be caused by malnutrition.

White patches in the mouth (thrush)

Thrush is a fungal infection that causes white patches and
soreness on the skin inside the mouth, on the tongue, and sometimes down the
tube that connects the mouth and stomach (esophagus). This can cause pain in the
chest.

Figure

The patches look like milk curds stuck to the cheek or tongue.
If the patches can be scraped off, it is probably thrush. Thrush happens more
often when someone is taking antibiotics.

Treatment:

Gently scrub the tongue and gums with a soft toothbrush or clean
cloth 3 or 4 times a day. Then rinse the mouth with salt water or lemon water
and spit it out (do not swallow). In addition, use any ONE of these remedies:

1. Suck a lemon if it is not too painful. The
acid slows the growth of the fungus. Or,

2. Rinse the mouth with 1% Gentian Violet liquid 2 times
a day. Do not swallow. Or,

3. Put I ml of nystatin solution in the mouth and hold it
there I minute and then swallow it. Do this 3 or 4 times a day for 5 days.
Or,

4. If thrush is very bad, ketoconazole may help. Take one
200 mg tablet, 2 times a day for 14 days (but do not take this medicine if you
are
pregnant).

Wounds and sores

Wounds are caused by an injury that breaks the skin. Sores are
often caused by bacteria or pressure on the skin (pressure
sores).They can happen very easily to people who stay in bed a long
time. Take special care of any cut, wound, or open sore so that it does not
become infected.

Figure

General care of open wounds and sores:

1. Wash the wound or sore with clean water
and mild soap at least once a day. Wash around the edge of the wound first, then
wash from the center out to the edges. If possible, use separate pieces of cloth
for each wipe.

Figure

2. If the wound has pus or blood in it, cover
the area with a clean piece of cloth or bandage. Leave the bandage loose, and
change it every day. If the wound is dry, it can be left open to the air. It
will heal more quickly that way.

3. If the wound is on the legs or feet, raise the leg
above the level of the heart. Do this as often as possible during the day.
During the night, sleep with the feet raised. Avoid standing or sitting for a
long time. Some walking is helpful.

Figure

4. Wash soiled cloth and bandages in soap and
water, then put them in the sun to dry. Or boil them for a short time and hang
them to dry. If the cloths and bandages will not be used again, burn them or
throw them in a pit latrine.

Home treatments for pressure sores

Papaya (paw paw): This fruit contains chemicals
that help make the old flesh in a pressure sore soft and easy to remove.

Figure

Soak a sterile cloth or piece of gauze in the milk
that comes from the trunk or green fruit of a papaya plant. Pack this into the
sore. Repeat this 3 times a day.

Honey and sugar: These will kill germs, help prevent
infection, and speed healing. Mix honey and sugar together into a thick paste.
Press this deep into the sore, and cover with a thick, clean cloth or gauze
bandage. (Molasses or thin pieces of raw sugar can also be used.)

Figure

IMPORTANTClean out and refill the sore at least
2 times a day. If the honey and sugar becomes too filled with liquid from the
sore, it will feed germs rather than kill them.

Treatment of open wounds and sores that ore
infected:

Wounds and sores are infected if they:

· become red,
swollen, hot, and painful.· have pus in
them.· begin to smell bad.

Treat the infected area as in steps 1 through 4 on the previous
page, and also do the following:

1. Put a hot compress over the wound 4
times a day for 20 minutes each time. Or try to soak the wound in a bucket of
hot water with soap or potassium permanganate in the water. Use one teaspoon of
potassium permanganate to 4 or 5 liters (or quarts) of water. When you are not
soaking the infected part, keep it raised up above the level of the heart

2. If part of the wound looks gray or rotten, rinse it
with hydrogen peroxide after soaking it. Try to pick off the gray parts with a
clean piece of gauze or tweezers that have been properly cleaned.

3. If you can, put Gentian Violet on the wound before
putting on the dressing.

4. If there are many infected sores at the same time,
especially with a fever, treat with antibiotics. Use erythromycin, dicloxacillin
or penicillin for 10 days (see the Green Pages).

Hot compress

¨Be careful: If you
use too much potassium permanganate or very hot water, you will burn the
skin.

Treatment of closed wounds that are infected (abscesses
and boils):

Abscesses and boils are raised, red, painful lumps on the skin.
They are most common in the groin and armpits, and on the buttocks, back,
and upper legs.

Figure

If you notice a lump, start using warm compresses right away for
20 minutes, 4 times a day. Often this will make the lump open and the pus inside
will come out. Keep applying clean, warm cloths until the pus stops coming out
and the area begins to heal. Cover the lump with a loose, clean bandage. If it
becomes too large and painful, see a health worker who has been trained to drain
abscesses using sterile equipment.

When to get help:

See a health worker trained to treat the signs of AIDS if you
have a wound and:

· a fever.· a red area around the wound is getting
bigger.

Get medical help if you have a wound and:

· you can feel
swollen glands in your neck, groin, or armpits.

· the wound has a bad smell, or
brown or gray liquid comes out, or it turns black and bubbles, or blisters form.
This could be gangrene.

· you are taking
antibiotics and not getting better

Mental confusion (Dementia)

Some mental confusion or mental change is common among people
with AIDS, especially if a person has been sick for a long time. These changes
may be caused by HIV infection in the brain, by other infections, by depression,
or by the side effects of a
medicine.

Pain

In the later stages of AIDS (and other serious illnesses like
cancer), pain may become a part of daily life. Pain can be caused by many
things, such as:

· not being able to
move.· pressure sores.· swelling of the legs and feet.· infections, like herpes.· headache.· nerve
pains

Treatment for pain, without medicines:

· Try relaxation
exercises, meditation, or prayer.

· Try to think about other
things.

· Play music, or have someone
read aloud or tell stories.

· For pain from swelling in the
hands and feet, try raising the swollen part.

· For a burning feeling in the
hands and feet caused by nerve pain, put the body part in water.

· For skin that hurts to touch,
line the bed with soft covers and pillows or animal skins. Be gentle when
touching the person.

Figure

· For headache, keep
the room dark and quiet.

· Acupressure may help some
kinds of pain.

Treatment for pain, with medicines:

The following medicines may be used to control pain that comes
day after day (chronic pain). Take the medicines regularly, according to
instructions. If you wait until the pain has become very bad, the medicines will
not work as well.

· mild pain
medicine, like paracetamol· ibuprofen - if
you need something stronger· codeine - if
the pain is very bad

¨ Pain medicines work best if
you take them before the pain gets very bad.

Figure

Caring for Someone Who Is Near Death

At some point there is nothing more that can be done for a
person with AIDS. You may know this time has come when:

· the body starts to
fail.· medical treatment is no longer
effective or is not available.· the person
says she is ready to die.

If the sick person wants to remain at home, you can help her die
with dignity by:

· giving
comfort.· having family and friends stay
with her.· allowing her to make
decisions.· helping her prepare for death.
It may help her to talk about death, about fears of dying, and about worries for
the familys future. It does not help to act as if she is not dying. Assure
her that you will do what you can to prevent pain and discomfort. Talk about
funeral arrangements if she wishes.

Figure

As she nears death, she may be unconscious, stop eating,
breathe very slowly or very fast and unevenly, stop passing urine, or lose
control of passing urine or stool.

Care of the body of someone who has died of AIDS

The AIDS virus can live up to 24 hours in a persons body
after death. During that time, take the same precautions with the body as you
did when the person was alive.

Working for Change

AIDS IS EVERYONES PROBLEM

It is important that everyone in the community know how AIDS is
spread and how to prevent it. But this information will not help them unless
they also realize that AIDS can happen to anyone - even them. If people think
that AIDS can not touch them, they will not act to prevent infection.

¨ Fight AIDS, not the people
who have it.

Placing the blame on any group of people (such as sex workers,
homosexuals, or drug users) makes others think that only that group is at risk.
It is true that some people, like sex workers, may be more likely to get AIDS
(because their work requires that they have sex with many men). But everyone -
especially young women - is at risk for AIDS. And every person in the community
needs to take responsibility for fighting it.

It is also important to remember to fight against the conditions
that lead to the spread of AIDS, and not against the people who have
AIDS.

How you can help prevent AIDS

In the community

Education is one of the main ways a community can work to keep
AIDS from spreading. Here are some ideas:

· Train girls and
women to work as peer educators. They can talk with others alone or in groups to
help girls and women understand their bodies and sexuality, and gain the
self-confidence and skills to demand safer sex.

· Tell the truth about
womens risk of AIDS. Help people see that AIDS has roots in poverty and in
womens lack of control over their sexual relations.

· Use theater and media to help
women feel it is OK to know about and to prevent AIDS. For example, use a play
or comic book to show that good girls or women can discuss AIDS with
their partners, or can buy condoms and ask their husbands or boyfriends to use
them.

Figure

At the same time, you can show different ideas about what it
means to be a man or a woman. Help people question the idea that men should have
many sex partners and that women should be passive about sex. Show how these
ideas are dangerous to both mens and womens health.

· Help parents,
teachers, and other adult role models become more comfortable talking about sex
and AIDS with young people.

· Make sure that all people have
access to information and sexual health services, including condoms, to keep
AIDS from spreading in the community.

· Bring education about AIDS to
community meeting places - like bars, schools, religious meetings, and military
bases.

Figure

Train men as outreach workers. They can go to the places
where men gather and talk to them about AIDS.

Here is an example of how women can work together to
protect themselves from AIDS:

To help fight the spread of AIDS, the women of Palestina, a
small town in northeastern Brazil, began a sex strike. After women
in the community learned that a man infected with HIV had unsafe sex with at
least two women in the town, they decided to stop having sex with their husbands
and boyfriends. They demanded that their partners take the test for HIV before
they would begin to have sex again and then insisted upon safer sex practices.

The women will now demand safer sex and proof of an HIV test
before they have sexual relations with a partner One woman said, If he
wont practice safer sex, we wont go together anymore.

If you are a health worker

Health workers can play a very important role in helping to stop
the spread of AIDS. You can do this if you:

· give information
about how AIDS is spread and how it is not spread to every person you see
- especially if they already have other STDs.

· encourage both men and women
to use condoms, even if they are already using another form of family planning.

· use precautions against HIV
infection with every person you see. Since most people with HIV appear healthy,
it is best to act as if everyone you care for is HIV-infected. Any time you have
to cut the skin or touch body fluids, follow the advice. This includes any time
you must give an injection, stitch skin or tissue, help with childbirth, or
examine a womans vagina.

· make health services private,
confidential, and accessible to all members of the community, including young
people.

· invite someone from a regional
AIDS organization to meet with health workers in your area. He or she can help
you learn about the best ways to treat the infections that people with AIDS
often get. Discuss the other problems that people with AIDS face. Try to decide
how you can help people using the resources you have, and think about where you
might find more resources to help meet peoples needs. If health workers
can work together and share resources, they will not have to confront this huge
problem alone.

¨ If every health worker can
offer the same information and services, it will save people time, money, and
energy because they will not have to search for the best treatment.

Fight the fear and negative attitudes that many people
have about AIDS

A good way to begin is to plan a meeting with other health
workers in your area to discuss AIDS. Help all the health workers learn about
AIDS so they will be able to provide accurate, consistent information to the
people in their communities. If all health workers can give the same
information, it will help prevent the fear caused by wrong ideas about AIDS.
With less fear from their neighbors, people with AIDS - as well as those who
care for them - can become more accepted in the community. Then they can help
others understand every persons real risk of getting AIDS.

Figure

A health workers sympathy and compassion can also help
others change their attitudes toward people with AIDS. Then she can fight
HIV/AIDS together with the community.